Correct Blood Pressure Measurement and Establishing Hypertension Thresholds

Measuring blood pressure might seem like a simple task, but research has identified 29 potential sources of error in the process. These errors can arise from the environment, the equipment, the patient, the procedure, or the person conducting the measurement.

Manuela Băbuș
Medical Writer
Correct Blood Pressure Measurement and Establishing Hypertension Thresholds
source: freepik

Even in medical offices, incorrect blood pressure measurement techniques can lead to overdiagnosis and overtreatment of hypertension. A medical article by Padwal R. (2019) highlights that a measurement difference of just 5 mm Hg can result in the incorrect classification of over 80 million people globally!

Recommendations for Accurate Blood Pressure Measurement

Blood pressure can be monitored both in a specialist clinic by a healthcare professional (doctor, pharmacist, nurse) and at home through self-monitoring

In all these cases, some basic rules must be followed.

The blood pressure measuring device must be validated. Either a classic sphygmomanometer or an electronic arm cuff monitor should be used. The use of electronic devices that attach to the wrist or smartwatches for blood pressure measurement is not recommended due to the significant errors they can produce.

For classic sphygmomanometers, the cuff size should be selected based on the circumference of the arm. If the cuff is too small, it will overestimate blood pressure; if it is too large, it will underestimate it.

For electronic blood pressure monitors, if the arm diameter is larger than 42 cm, the cuff should be conical, as a rectangular cuff would overestimate blood pressure in this case.

Blood pressure monitors should be periodically revalidated.

Measurement Technique

The patient should not have eaten, smoked, consumed alcohol, or engaged in physical activity at least 30 minutes prior. Blood pressure should be measured in conditions of thermal comfort and quiet. The patient should sit on a chair with back support, with the elbow resting on a side table so that the cuff is at heart level, and feet flat on the floor; the patient should not speak during the measurements.

In a clinical setting: Three measurements are taken at 1-minute intervals, and the average of the last two measurements is used. For home measurements, the individual takes two measurements and averages them.

A diagnosis of hypertension is only made after a single visit to the doctor's office if the patient presents with a very high value, such as 180/110 mmHg, during that visit. Otherwise, the patient is asked to return within 4 weeks to confirm or rule out the diagnosis of hypertension.

Hypertension Guidelines Encourage Home Blood Pressure Monitoring

Hypertension guidelines recommend self-monitoring of blood pressure at home, especially before a patient’s visit to the medical office, to compare home and office blood pressure values. Home blood pressure measurement helps avoid white-coat hypertension, where a patient's blood pressure rises suddenly during measurement due to anxiety about having hypertension, and masked hypertension, where blood pressure drops during measurement due to fear of being diagnosed with hypertension.

For elderly patients over 65 who are undergoing treatment for hypertension, blood pressure should also be measured in a standing position to check for orthostatic hypotension development.


Hypertension is a chronic disease and is the leading cause of cardiovascular morbidity and cardiovascular mortality. Therefore, it is crucial to diagnose it accurately and timely and to treat it appropriately.

Medical Guidelines recommendations

Medical guidelines recommend that any person aged 18 to 79 with blood pressure readings of 140 mmHg (systolic) and/or 90 mmHg (diastolic) should be diagnosed with hypertension and prescribed medication.

For patients over 80, who are more fragile and have stiffer blood vessels, lower blood pressure levels can lead to falls. Therefore, a more flexible range of 140 - 160 mmHg is recommended for initiating blood pressure-lowering medication. Treatment for these patients is individualized based on other conditions they may have and the complexity of their overall treatment regimen.

It is crucial for elderly patients to maintain a correct risk-benefit balance between the advantages of lowering blood pressure and the risks associated with overly aggressive blood pressure reduction.

Patients with coronary artery disease require cardiovascular protection against hypertension starting at blood pressure levels of 130-140 mmHg (systolic) and 80-90 mmHg (diastolic). At these so-called high-normal values, they need medication to control their blood pressure.

For those aged 65 to 79, current medical guidelines target blood pressure levels below 140/90 mmHg. However, if the patient tolerates blood pressure reduction well, it can be further lowered to below 130/80 mmHg.

In summary, the ideal blood pressure range is a systolic pressure of 120-140 mmHg and a diastolic pressure of 70-80 mmHg.

The Role of Lifestyle in Reducing Blood Pressure

Lifestyle continues to play a crucial role in reducing blood pressure. 

Overweight or obese patients are strongly recommended to lose weight, as this alone can lead to significant reductions in blood pressure.

Diet is also important, with an emphasis on increased consumption of vegetables, reduced intake of animal products, and minimal consumption of processed foods. 

Special attention should be given to reducing salt intake. It is beneficial to limit salt intake to no more than 5 grams per day, which is equivalent to 2 grams of sodium.It is recommended to use supplements containing potassium chloride instead of sodium chloride.


In conclusion, managing hypertension is a multifaceted approach that requires both medical intervention and lifestyle adjustments. Accurate diagnosis, timely treatment, and regular monitoring are essential to prevent the serious complications associated with high blood pressure, such as cardiovascular diseases and strokes. Patients should be proactive in self-monitoring their blood pressure, adhering to prescribed treatments, and making necessary lifestyle changes, including diet and weight management.


The information provided in this article is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.

Article Citations & Bibliography
  1. Mancia G. et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023 Dec 1;41(12):1874-2071. doi: 10.1097/HJH.0000000000003480. Epub 2023 Sep 26. Erratum in: J Hypertens. 2024 Jan 1;42(1):194. PMID: 37345492.

  1. Padwal R. et al. Optimizing observer performance of clinic blood pressure measurement: a position statement from the Lancet Commission on Hypertension Group. J Hypertens. 2019 Sep;37(9):1737-1745. doi: 10.1097/HJH.0000000000002112. PMID: 31034450; PMCID: PMC6686964.

Please note that the information provided on this blog is for educational and informational purposes only. It is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog.

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Manuela Băbuș.
Medical Writer